THE TOURISM-LED GROWTH HYPOTHESIS IN TRANSITION ECONOMIES? EMPIRICAL EVIDENCE FROM A PANEL DATA ANALYSIS

Tourism has been considered as a potential factor in development strategy in many developed and developing countries worldwide. Besides, tourism is really a key economic sector in some countries. This study aims to examine the tourism-led growth hypothesis for some transition countries, which includes seven high growth economies Bulgaria, Hungary, Poland, Romania, Russia, Ukraine and Vietnam. The research database is collected by an annual form in the period of 1995-2019. These economies are considered successful transitional cases in the global economy, however, the tourism-led growth hypothesis in these countries has been received only a little evidence from academics in recent years. The Johansen-Fisher test and the OLS estimation are applied in the quantitative process. There are some new findings from the empirical results. First, the Johansen-Fisher test confirms the existence of long-run cointegration relationships between tourism (denoted by the tourism revenue and the tourism arrivals) and economic growth in the panel data sample of countries. Second, the long-run coefficients of the tourism variables are positive and significant that concludes the tourism-led growth hypothesis in these transition countries. The contribution of the study is not only to fill the empirical research gap by the estimated results from a group of transition economies but also to confirms the tourism-led growth platform as an efficient development strategy for other developing countries. Furthermore, our study suggests some policy implications for policymakers to use tourism as a key development sector in these countries in the future.

Verbitterung und Aggression bei Psychotherapiepatienten

Zusammenfassung Einleitung Die Emotion Verbitterung ist jedem Menschen geläufig. Sie geht mit erheblichem Leid für die Betroffenen und ihre Umwelt einher, wozu auch dysfunktionales Verhalten und Aggressionsgedanken gehören. Dies ist auch ein Thema bei Psychotherapiepatienten und sollte angemessene therapeutische Aufmerksamkeit erfahren. Allerdings gibt es zur Häufigkeit von Verbitterung und assoziierter Aggression bei Patienten in ambulanter Psychotherapie bislang nur unzureichende Daten. Material und Methoden Erwachsene Patienten eines Verhaltenstherapieinstituts füllten die PTED Skala (Post-Traumatic Embitterment Disorder Selbstauskunftskala), den K-FAF (Kurzfragebogen zur Erfassung von Aggressivitätsfaktoren) und die SCL-90-S Skala (Symptom-Checkliste-90-Standard) aus. Weiterhin standen soziodemografische Routinedaten zur Verfügung. Ergebnisse 118 Patienten mit einem Durchschnittsalter von 38 Jahren (SD=13,3 Jahre; R=18,76 Jahre) nahmen an der Untersuchung teil. Der Mittelwert der PTED-Skala betrug M=1,8 (SD=0,81; R=0–3,38). Eine klinisch signifikante Verbitterungssymptomatik mit einem Cut-off-Wert von M≥2,5 erreichten 22% der Untersuchten. Der mittlere Summenwert der Aggressivitätsskala (gesamt) beträgt 30,25 (SD=17,94). 23,7% der Patienten hatten einen auffälligen reaktiven Aggressivitätswert (Cut-off≥18,37) und 54,2% der Patienten einen auffälligen Wert für erregbare Aggressivität (Cut-off≥14,8). Es konnte ein signifikanter Zusammenhang zwischen der PTED-Skala und der Aggressivitätsskala (gesamt) (r=0,422, p<0,001), wie auch in den Unterkategorien „erregbare Aggressivität“ (r=0,355, p <0,001) und „reaktive Aggressivität“ (r=0,425, p<0,001) gefunden werden. Bei Vergleich von Patienten mit erhöhter Verbitterung, erhöhter Aggression, erhöhter Verbitterung und Aggression (Komorbiditätsgruppe) und unauffälligen Patienten hinsichtlich des Grades der psychischen Belastung fand sich ein höherer Wert in der Komorbiditätsgruppe im Vergleich zur unauffälligen Gruppe (GSI der SCL-90-S: f(3,71)=4,00, p=0,011), sowie eine höhere Rate an Arbeitslosigkeit (Fisher-Test p=0,008). Es fanden sich keine signifikanten Unterschiede zwischen den Gruppen und sonstigen soziodemografischen Variablen (Alter, Geschlecht, Familienstand und Bildung). Diskussion und Schlussfolgerung Die Daten zeigen, dass Verbitterung und Aggression im ambulanten psychotherapeutischen Kontext mit relevanter Häufigkeit vorkommen und theoriekonform miteinander in Verbindung stehen. Deshalb sollten ambulante Psychotherapiepatienten stets diesbezüglich befragt werden, um adäquat intervenieren zu können.

Violências relacionadas ao trabalho e variáveis associadas em profissionais de enfermagem que atuam em oncologia

Resumo A violência ocupacional é um agravo ao qual os profissionais de saúde estão cotidianamente expostos. O objetivo deste artigo é identificar a prevalência de violência no trabalho (verbal/física) e as variáveis relacionadas em profissionais de enfermagem atuantes em oncologia. Estudo transversal, em que a agressão física ou verbal foi avaliada por meio do autorrelato. Analisou-se a relação entre as variáveis sociodemográficas, psicoemocionais e relacionadas ao trabalho violência (verbal/física) por meio dos testes Qui-Quadrado, exato de Fisher, Test T Student e Mann-Whitney. A amostra do estudo foi composta por 231 profissionais de enfermagem. A prevalência de agressão física ou verbal referida no último ano foi de 61,5%. Maior prevalência de agressão foi evidenciada nos profissionais que afirmaram apresentar-se cansados ao final do plantão e com concentração diminuída durante este turno. Destaca-se que os trabalhadores que sofreram violência apresentaram Burnout em alto nível em todas as subescalas, maior escore médio na escala de estresse no trabalho e pior qualidade do sono. Os achados do presente estudo apontam para necessidade de medidas institucionais para prevenção e controle da violência ocupacional.

Funktionelles Outcome nach konservativer im Vergleich zu operativer Therapie von 111 Mittelfußfrakturen

Zusammenfassung Hintergrund Mittelfußfrakturen gehören zu einer der häufigsten Verletzungen des Fußes und treten v. a. bei Patienten zwischen dem 40. und 50. Lebensjahr auf. Insbesondere die Verletzung mehrerer Mittelfußknochen kann zu bleibenden Einschränkungen führen, und daher war das Ziel dieser Studie, das funktionelle Outcome von Mittelfußfrakturen mittels eines validierten selbstberichteten patientenbasierten Ergebnisfragebogens zu untersuchen. Material und Methoden Im Zeitraum von 2003 bis 2015 wurden alle Patienten mit einer Mittelfußfraktur mit konservativer sowie operativer Behandlung in diese retrospektive Kohortenstudie eingeschlossen. Es wurden demografische Daten, Art der Fraktur (AO-Klassifikation), Behandlung, Reoperationsrate sowie das funktionelle Ergebnis mittels Foot and Ankle Outcome Score (FAOS) erfasst. Der Mann-Whitney-U-Test und Exakte Fisher-Test wurden bei der statistischen Analyse eingesetzt. Ergebnisse Insgesamt wurden in diese Studie 111 Patienten mit 81 isolierten und 30 multiplen Mittelfußfrakturen eingeschlossen. Das Durchschnittsalter der Patienten war 45 ± 15,2 Jahre mit insgesamt 48 Männern (43 %) und 63 Frauen (57 %). Patienten mit isolierter Mittelfußfraktur hatten einen FAOS von 88 ± 17,1. Die Patienten mit multiplen Mittelfußfrakturen erzielten einen FAOS von 78 ± 17,7 (p = 0,046). In der Gruppe der isolierten Mittelfußfrakturen wurden 43 Patienten (53 %) operativ behandelt. Hiervon zeigten 36 Patienten eine C‑Fraktur (84 %). In der Gruppe der multiplen Mittelfußfrakturen wurden 16 Patienten (53 %) operativ behandelt. Diskussion Das funktionelle Outcome nach isolierten Mittelfußfrakturen ist sowohl nach operativer als auch konservativer Therapie gut bis sehr gut. Einfache Frakturen lassen sich erfolgreich konservativ und komplexe, mehrfragmentäre Frakturen operativ behandeln. Bei Frakturen von mehr als einem Mittelfußknochen ist das Ergebnis signifikant schlechter, und es bleiben vom Patienten berichtete Einschränkungen zurück.

SYK gene mutations with TMB-H and MSI-H in solid tumors.

e14572 Background: Spleen tyrosine kinase ( SYK) gene encodes a cytoplasmic non-receptor tyrosine kinase (NRTK) and mediates signal transduction downstream of multiple transmembrane receptors, which plays an important role in a variety of signaling pathways. The change of SYK gene expression and gene mutations may lead to the formation and metastasis of multiple solid tumors. Previous studies on SYK mostly focus on the protein isomers and the methylation of SYK gene promoter. We previously used next generation sequencing (NGS) to explore SYK gene mutations on DNA level and found novel mutation types of SYK gene. Herein, NGS were performed to explore the relationship of SYK gene mutations with TMB and MSI in solid tumors for further clinical research. Methods: We retrospectively collected NGS detection data by 539-gene panel in 5648 patients with pan-cancer, of which 3931 patients by tumor tissue and 1717 patients by blood ctDNA, and screened out somatic SYK gene mutations. 539-gene panel contained all exon regions of SYK gene. Then we divided 5648 patients into four groups depending on whether SYK gene mutations: tumor tissue mutant group (T-mut) / non-mutant group (T-non-mut), and ctDNA mutant group (ctDNA-mut) / non-mutant group (ctDNA-non-mut). The difference in TMB between T-mut and T-non-mut groups; between ctDNA-mut and ctDNA-non-mut groups were analyzed via the Wilcoxon sign test respectively. The difference in MSI between T-mut and T-non-mut groups were analyzed via Fisher test. Results: In 5648 patients with solid tumors, 64 patients (48/3931 in tumor tissue and 16/1717 in blood ctDNA) were found harboring SYK gene mutations and the mutation frequency was 1.13%. TMB in T-mut group was higher than in T-non-mut group and significant difference of TMB was found via the Wilcoxon sign test (p = 5.3e-12) between the two groups. TMB in ctDNA-mut group was higher than in ctDNA-non-mut group and significant difference of TMB was found too (p = 4.6e-05). 12 patients were found MSI-H in T-mut group (12/48) and 53 patients were found MSI-H in T-non-mut group (35/3875). We found significant difference in the probability of MSI-H occurrence between the two groups by Fisher test (p = 6.531e-12, HR: 23.933, 95%CI: 10.734-50.415). Conclusions: This is the first report on the relationship between SYK gene mutations with TMB and MSI in solid tumors and we found that SYK gene mutations are associated with TMB-H and MSI-H in solid tumors. As a retrospective study in solid tumors, the conclusion and the mechanism need to be studied in the future.

Factors Related To The Actions Of Midwives In Providing Antenatal Care

Background: Midwives' actions under service standards are useful in applying the norms and performance levels needed to achieve the desired results. Midwives in providing antenatal care will have a significant impact on antenatal care services Methods: This study used a cross-sectional design. This study's population was 41 midwives who worked in the District of Kota Pinang, Labuhanbatu Selatan Regency (total sampling). The instrument used was a questionnaire about age, education, knowledge, attitudes, and midwives' actions in providing antenatal care. The bivariate analysis used exact fisher test and prevalent rate (PR). Results: The exact fisher test results showed that the midwife's age (p = 0.192), education (p = 0.175), knowledge (p = 0.390) (PR = 2.311) were not related to the midwife's actions in antenatal care. The variable of midwife attitudes (p = 0.018) (PR = 5,500) was related to the actions of midwives in antenatal care. Conclusion: A midwife who has a good attitude has a risk taking good actions than a midwife who has a bad attitude. It is hoped that the South Labuhanbatu Health Office will be more active in improving the skills of midwives in providing antenatal services with training on antenatal care..

Provide a model to identify the effect of the occurrence of business cycles on financial uncertainty in the stock market Developed countries

On financial uncertainty (variance of S&P index growth rate). Also, considering that the coefficient of determination of the regression model (R2) is equal to 0.984 and is close to the number one, that is, the Fisher test (F) is significant (its probability is less than 0.05), so the regression model is justifiable and acceptable. Hypothesis H0 is therefore rejected and Hypothesis H1 is accepted with 95% probability, or in other words, business cycles have a significant effect on financial uncertainty in the stock market of developed countrie

Therapy-Related AML (t-AML), a Heterogeneous Disease: Multicenter Analysis on Biological and Clinical Differences between Cases Following Breast Cancer and Lymphoma Treatment

BACKGROUND Therapy related AML (tAML), a late complication of chemo and/or radiotherapy (RT) for a prior neoplasm, most often develops after breast cancer (BC) and lymphoproliferative disorders (LD). T-AML pathogenesis may involve 1) induction of a fusion oncogene, most often caused by use of topoisomerase II inhibitors, 2) genome instability, often amplified by p53 mutations, developped most frequently after alkylating agents and radiotherapy and 3) selection of pre-existing hematopoietic cell clones (a condition known as CHIP) under chemotherapy pressure. Moreover, genetic susceptibility, i.e. mutations in genes involved in DNA damage-sensing and repair (BRCA 1 and 2, p53, Fanconi genes, BCL2L10), may play a role in the development of a second cancer. Finally some cases of tAML, may be temporally consequent but not etiologically related to previous treatment, an event more likely if the primary cancer is more frequent in the general population (as, for example, breast cancer). The aforementioned etiological factors may be involved with greater or smaller importance in different tAML patients groups and result in clinical heterogeneity even in patients classified in the same WHO AML category, with heterogeneous disease features and response to therapy. AIM OF THE STUDY AND METHODS We analysed data about patients treated at two Italian hospitals, ASST Niguarda Ca' Granda (Milan) and Policlinico San Martino (Genoa) from year 2009 to 2019 for a tAML secondary to breast cancer or to LD (Hodgkin and non Hodgkin lymphoma) and looked for possible differences in the clinical and genetic characteristics and response to therapy (i.e. achievement of CR). Descriptive statistics was used for categorical variables. Furthermore, Fisher exact test was used to compare the frequency of different genetic prophiles and response to therapy in different tAML patient populations. RESULTS Clinical and genetic characteristics of the patients, as well as data on previous treatment and response to therapy of tAML cases are reported in the table. Median age and time to AML onset were similar in the two groups of patients (BC and LD) and both had been largely treated with chemotherapy (including anthracyclines and alkylators) and radiotherapy, even if the use of chemotherapy was more extensive in lymphomas, with a significant proportion of patients also receiving HD chemotherapy and ASCT. We found biological and clinical differences between the two cohorts of tAML patients: Patients with previous BC had a genetic profile that is closer to that of de novo AMLs, with an high frequency of normal karyotype or recurrent translocations, including cases of CBF AML and PML. A MDS-related karyotype was found only in a minority of patients. Conversely, patients treated for a previous lymphoma had a much higher proportion of MDS-related cytogenetics (14/23 in LD vs 5/20 in BC, Fisher test, p=0,03), with only 7/23 patients harbouring a normal karyotype. As regards response to chemotherapy, the proportion of patients achieving a CR was 16/20 in breast cancer group, compared to 11/23 in LD patiens, a difference nearly achieving statistical significance (Fisher test, p=0,06). This difference was observed in spite of a larger use of fludarabine containing regimens in the latter cohort (according to clinicians choice). CONCLUSIONS Our data suggest that tAMLs, even if categorized as a whole in WHO 2016 classification, are a heterogeneous entity as regards pathogenesis and clinical behaviour and may deserve a personalized approach. The use of a wide genetic screening may help to discriminate the biological characteristics and prognosis of each patient with possible implications in therapeutic choices. Figure Disclosures No relevant conflicts of interest to declare.

Tumor Microenvironment Associated with Complete Response to Tislelizumab Monotherapy in Relapsed/Refractory Classical Hodgkin Lymphoma Reveals a Potentially Different Mechanism of Action

Background: Tislelizumab, a humanized immunoglobulin 4 monoclonal anti-programmed cell death protein 1 (anti-PD-1) antibody, has an engineered Fc region that minimizes binding to Fcγ receptor (FcγR) on macrophages, thereby abrogating antibody-dependent phagocytosis (ADCP)-induced T-cell clearance. Tislelizumab demonstrated an overall response rate of 87.1% with a high complete response (CR) rate (62.9%) and was generally well tolerated in a phase 2 study in Chinese patients with relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL) (BGB-A317-203 study; clinicaltrials.gov identifier: NCT03209973). The present study explored the underlying mechanism of action (MOA) of tislelizumab and its potential contribution to the high CR rate associated with it in patients with R/R cHL. Methods: Seventy patients with confirmed R/R cHL were included in this study. Tissue samples were collected at baseline for biomarker testing. Forty-one samples were evaluable for multiple immunohistochemistry (mIHC) assays, and 36 samples were evaluable for gene expression profiling (GEP). For programmed death-ligand 1 (PD-L1), CD8 (cytotoxic T-cell marker), CD68 (macrophage pan-marker), CD64 (FcγRΙ), and CD30, mIHC samples were stained using Opal 7-Color IHC kit. Spatial analysis for the markers was conducted using HALO software. GEP utilized the HTG EdgeSeq Precision Immuno-Oncology panel. Genes expressed differentially in CR and non-CR were identified using the Lima R Bioconductor package. Gene signature score was calculated by the gene set variation analysis method. Median value across the biomarker population was used as the cutoff to define biomarker high versus low group. Differential biomarker tests between CR and non-CR were conducted by Wilcoxon rank-sum test. Results: For anti-PD-1 antibodies with a functional Fc, the Fc/FcγR interaction resulted in macrophage-induced T-cell clearance and dampened anti-tumor activity, while tislelizumab activity was not affected by macrophages in the mouse cancer model (Zhang T, et al. Cancer Immunol Immunother. 2018;67:1079-1090). In cHL clinical samples, we observed a similar CR rate for tislelizumab in FcγRΙ+ macrophages (CD68+CD64+) high versus low group (71.4% vs 60%, P=0.85 by Fisher-test). In the CD8+ T-cell high microenvironment where ADCP-induced T-cell clearance is more likely, neither the total number of CD68+/CD64+ cells (CR rate 86.6% for high vs 85.7% for low, n.s. by Fisher-test) nor the average number of CD68+CD64+ cells within 30 µm of CD8+ T cells (85.7% vs 80%, n.s. by Fisher-test) were observed to affect the CR rate. Additional tumor microenvironment components that may contribute to the high CR rate were also explored. We found that FcγRΙ+ and CD8+ cell percentage by mIHC were higher in CR patients (P=0.04 and P=0.08, CR vs non-CR). GEP results show that the tumor inflammation gene signature (TIS) (eg, CD8A, CCL5, PD-L1, IDO1, IFNG, CXCL9) were higher in CR patients (CR vs non-CR, P=0.04). Specific gene/gene signatures were associated with CR for different histology subtypes. In the mixed cellular subtype, CD8+ T cells by mIHC (P=0.0004) and the TIS gene signature by GEP (P=0.007) showed a larger difference between CR and non-CR. In the nodular sclerosis subtype, the extracellular matrix and fibroblast-related gene signature (eg, ICAM, COL1As, ITGAs, PDGFRB) were higher in CR patients (P=0.04, CR vs non-CR). Conclusions: Tislelizumab demonstrated a high CR rate regardless of the FcγRΙ expressing macrophage abundance in the cHL tumor microenvironment, which may be a functional consequence of its engineered Fc region and may differentiate its MOA from the MOAs of other anti-PD-1 agents. CD8+ T-cell abundance and tumor inflammatory gene signatures in the microenvironment may be associated with higher CR rate for cHL patients treated with tislelizumab. Disclosures Wang: BeiGene Co., Ltd.: Current Employment, Current equity holder in private company. Zhang:BeiGene Co., Ltd.: Current Employment, Current equity holder in private company. Liu:BeiGene Co., Ltd.: Current Employment, Current equity holder in private company. Zhang:BeiGene Co., Ltd.: Current Employment, Current equity holder in private company. Shen:BeiGene Co., Ltd.: Current Employment, Current equity holder in private company. Wang:BeiGene Co., Ltd.: Current Employment, Current equity holder in private company. Yang:BeiGene Co., Ltd.: Current Employment, Current equity holder in private company. Guo:BeiGene Co., Ltd.: Current Employment, Current equity holder in private company.